Provider Demographics
NPI:1760127443
Name:TRAIT OF LIONESS, LLC
Entity Type:Organization
Organization Name:TRAIT OF LIONESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-434-9384
Mailing Address - Street 1:863 LILLIAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-0711
Mailing Address - Country:US
Mailing Address - Phone:706-434-9384
Mailing Address - Fax:
Practice Address - Street 1:863 LILLIAN PARK DR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-0711
Practice Address - Country:US
Practice Address - Phone:706-434-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)